Yellow eyes - causes, treatment and prevention

Yellow eyes - causes, treatment and prevention

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Yellowish discoloration in the eye - yellow whites of the eyes

Yellow eyes mostly indicate a disease of the liver or bile. However, as is often assumed, this is not always the case
a so-called "jaundice" (jaundice), which can instead be caused by inflammation of the liver (hepatitis) or gallstones.

Another possible cause is the harmless, genetically determined metabolic disorder "Meulengracht's disease", also called Gilbert syndrome, which affects about 5% of the population. Accordingly, yellow eyes do not automatically indicate a serious illness - nevertheless, those affected by discoloration of the white eye skin should in any case immediately consult a doctor for more precise clarification.


Yellow eyes are usually used when the white skin of the eye (sclera or "leather skin") has turned yellow or yellow. In most cases, this is due to a disease of the liver or bile, especially if the skin and mucous membranes turn yellow as well as painful symptoms. In order not to take any risks, a doctor should be consulted immediately in the event of discolouration of the sclera in order to have the cause clarified.

Common cause: jaundice (jaundice)

The most common cause of yellow eyes is the so-called "jaundice" (medical: jaundice), which is a yellowing of the skin, mucous membranes and the dermis of the eyes (sclera). However, jaundice is not a separate disease, but a symptom that occurs with various underlying diseases.

The yellowish discoloration of the eye is caused by the yellow-brownish bilious pigment "bilirubin", which mainly occurs when the red blood pigment (hemoglobin) is broken down (Latin bilis = bile and ruber = red). The non-water-soluble bilirubin is first converted into water-soluble bilirubin in the liver, thus reaching the intestine via the biliary tract and finally being largely excreted in the stool. However, if, for example, the metabolism or bile drainage is disrupted, the bilirubin cannot be excreted accordingly - as a result, the concentration of the bile pigment in the blood increases, which can lead to jaundice.

If the eyes turn yellow, in most cases a disease of the liver is suspected, accordingly there is often no difference between jaundice and hepatitis (inflammation of the liver). But the former can have a variety of causes and has long since affected more than just the liver. Nevertheless, the suspicion of a sick liver is often confirmed, so that in the case of yellow eyes, a doctor should always be consulted as soon as possible for a safe diagnosis.

Three types of jaundice

If jaundice is indeed present, three types are medically distinguished:

1.) The so-called "Hemolytic jaundice" arises from a premature or increased breakdown of red blood cells (hemolysis), which means that indirect bilirubin accumulates in the blood and the liver can no longer break down the dye. As a result, bilirubin is deposited in the tissue and there is the typical discoloration of the skin and eyes.

In this case, blood disorders are usually the cause, such as the almost exclusively congenital "spherical cell anemia". There are also various immune-related diseases that are associated with the destruction of blood cells by antibodies, which can also occur as a result of repeated blood transfusions. Other causes of hemolytic jaundice can be, for example, malaria, other viral infections, burns, poisoning or an artificial heart valve, since the blood cells can be damaged by constant contact with metal.

In addition to the yellow color, a dark stool and red-brown urine often occur in hemolytic jaundice, depending on the cause of the disease, there are other symptoms such as fever, fatigue or nausea. Since the hemolytic form basically originates outside or in front of the liver, the term “prehpatic jaundice” (composition of the Latin pre = before and Hepar = liver) is often used.

2.) With one "Hepatic jaundice" however, bilirubin is no longer absorbed by the liver cells or only in a reduced form. The causes can be found here in comparison to the preopathic form in the liver, often it is inflammation of the liver (hepatitis).

These can be caused, for example, by viruses (e.g. hepatitis B) or medications (e.g. paracetamol, antibiotics such as tetracycline or rifampicin, estrogens, testosterone). In most cases, however, alcohol is the trigger for severe liver damage in the context of hepatic jaundice, which can lead to advanced liver scarring (cirrhosis of the liver) or even liver cancer (liver cell carcinoma).

In hepatic jaundice, the stool is usually normal or a little lighter in color, and depending on the cause, there are various other symptoms such as abdominal pain, nausea and vomiting or chronic fatigue in addition to yellow eyes and yellow skin.

3.) The third variant is considered medically "Posthepatic jaundice" (or "cholestatic jaundice"), because the problem arises in this case only after the liver has already made bilirubin water-soluble and therefore in principle excreted (Latin post = after, hepar = liver). But this is precisely where posthepatic jaundice comes in, because the bilirubin that is now in the bile cannot get into the intestine due to an obstacle in the biliary tract, which causes it to build up in the blood and cause the eyes and skin to turn yellow.

As a result of the impaired bile drainage (cholestasis), in addition to the yellowing of the eyes and skin, there is often a constant itching sensation due to the increased bile acid. Another symptom of posthepatic jaundice is pale stool, because since bilirubin no longer reaches the intestine, the corresponding breakdown product (stercobilinogen), which is responsible for the normal light to dark brown color of the stool, is also missing.

It is the other way around with the urine, which in the posthepatic form is often dark brown or "beer brown", because since the yellow-brown bilirubin can no longer drain through the bile, it first migrates into the blood and is ultimately excreted via the kidney.

In most cases, the obstacle in the bile ducts is a gall stone that blocks the flow of bile, for example, at the mouth of the bile duct. Overall, women are affected more often than men. Genetic factors are usually assumed to be the cause, and obesity could also play a role from the experts' point of view.

Adhesions due to surgery or a tumor in the area of ​​the pancreas head or biliary tract are also possible. In such a case, other symptoms such as severe upper abdominal pain as well as a significant weight loss become apparent. The gallstones, on the other hand, only cause problems in some cases, such as nausea and pain in the upper abdomen after eating, in some cases the abdominal pain can also be severe and cramp-like in the back (colic).

Newborn jaundice

A common “special form” of hemolytic jaundice is “newborn jaundice”, which occurs in about 60% of all newborns two to three days after birth and usually subsides after about a week. This also leads to yellow coloring of the eyes and skin in the infants, sometimes with slower movements, a weakened ability to react and a reduced desire to drink.

Despite the symptoms, jaundice in newborns is in most cases not disease-related. Instead, this form of jaundice is almost always an "adaptation disorder" of the liver that is not yet fully developed and therefore the bilirubin cannot yet be converted and excreted accordingly. As a result, the increased amount of bile pigment in the body causes the skin and mucous membranes to turn yellow.

This can also happen if red blood cells (erythrocytes) are broken down in large quantities, for example due to a blood group intolerance between mother and child or with certain forms of congenital anemia (anemia). In rare cases, bruising after birth can also lead to jaundice in newborns, because the metabolism of the hemoglobin contained in it creates an increased amount of bilirubin, which in turn cannot yet be broken down by the liver.

Furthermore, premature birth, certain medications or disorders of the metabolism, such as an underactive thyroid gland, can lead to the liver not keeping up with the conversion and excretion of the bile pigment, which results in jaundice.

In some cases there is a so-called "breast milk icterus": jaundice is caused by breastfeeding, where it is assumed that the proteins in breast milk block bilirubin breakdown.

Although jaundice in newborns is mostly harmless, there are also cases in which bilirubin levels in the blood rise too high and there is a risk that nerve tissue or even certain areas of the brain can be damaged (nuclear icterus). In addition to the yellowing of the eyes and skin, there is often reduced activity for the baby in that he drinks little, is permanently sleepy and often yawns. In the further course there can also be shortness of breath, cramps, increased muscle tension and increased screaming.

Yellow eyes due to familial hyperbilirubinemia syndrome

If there are no indications of any of the diseases mentioned, the cause can be a so-called "familial hyperbilirubinemia syndrome", which refers to various hereditary metabolic disorders, all of which are characterized by an increased bilirubin concentration in the blood - but have hardly any disease value.

The most common form is the mostly harmless one Meulengracht's disease (also Gilbert syndrome), which affects about 5% of the population (mainly young men). In this “disease”, a congenital enzyme defect means that the bilirubin cannot be completely broken down and consequently collects in the blood.

In most cases, Meulengracht patients have no symptoms at all, the only symptom is often the temporary yellowing of the skin and eyes. In rare cases, however, there are also more severe - usually relapsing - symptoms such as severe tiredness, nausea, listlessness or difficulty concentrating. In addition, there are possible complaints such as indigestion or abdominal cramps, which, however, primarily affect particularly slim patients after consuming alcohol or nicotine, since these substances lead to an increase in the bilirubin value.

Since the concentration of the bile pigment is increased in such a case, but there are usually no increased liver values, there is usually no increased itching in Meulengracht's disease - as is the case with posthepatic jaundice, for example.

There are other familial hyperbilirubinemia syndromes that can cause yellowing of the eyes, but are much less common compared to Meulengracht's disease. For example,Crigler-Najjar syndrome“A hereditary disease with a frequency of 1: 1 million in newborns, which primarily affects the liver. This syndrome is also caused by an enzyme defect, which is responsible for bilirubin excretion, but the defect is far more pronounced than in Meulengracht's disease.

A distinction is made between two types: Crigler-Najjar syndrome type 1, which occurs immediately after birth and is characterized by an excessively high concentration of bilirubin in the blood (hyperbilirubinemia), which in the absence of therapy usually leads to severe damage to the central nervous system (" Kernikterus ”) and thus untreated patients usually die in early childhood.

The course of Crigler-Najjar syndrome type 2, however, is less extreme, a nuclear icterus occurs only in rare cases. Instead, it only shows symptoms of jaundice, such as the yellowing of the skin and eyes and severe itching.

Dubin-Johnson syndrome and Dubin-Johnson syndrome

Also at "Dubin-Johnson syndrome“Is a very rare hereditary disease of the liver, in which there is a disturbance in the excretion of the“ direct ”, water-soluble bilirubin into the bile. Dubin-Johnson syndrome - which primarily affects women - is also visible through the typical symptoms of jaundice, which is often triggered by diseases, pregnancy, oral contraceptives (contraceptives) or medication. Apart from the occasional phases of jaundice, there are usually no other symptoms in this disease, so therapy is usually not necessary.

Clinically similar to Dubin-Johnson syndrome is the so-called "Rotor syndrome“, Which also occurs very rarely, but affects both genders equally. With this hereditary disease, the excretion of direct bilirubin into the bile is disturbed due to a genetic defect. Apart from jaundice, there are usually no other symptoms, in rare cases there are unspecific complaints in the area of ​​the right upper abdomen and fever. Accordingly, no treatment is usually necessary.

Summerskill-Walshe-Tygstrup syndrome

The so-called Summerskill-Walshe-Tygstrup syndrome (or "benign recurrent cholestasis") is also one of the rare inheritable hyperbilirubinemia syndromes, in which a direct genetic bilirubin increase in the blood primarily occurs in children and young adults due to a genetic defect.

This syndrome is characterized by chronic recurrent jaundice episodes with discoloration of the eyes, mucous membranes and skin, as well as other typical symptoms such as fatigue, loss of appetite, nausea, itching and tenderness in the right upper abdomen. Among other things, pregnancy or infection can be the trigger for Summerskill-Walshe-Tygstrup syndrome - in most cases, however, the specific trigger cannot be clearly clarified. There is no specific therapy, and usually only symptomatic treatment during the jaundice episodes.

Yellow discoloration of the eyes

Another cause can be the so-called "yellow fever". It is a viral infection caused by the yellow fever virus and, like malaria, is transmitted by mosquitoes. This belongs to the so-called "flaviviruses", whose family also includes the dengue virus and the hepatitis C virus. The incubation period is three to six days, then there is a sudden fever, accompanied by headache, chills, back pain, loss of appetite, nausea and vomiting.

In most cases, the symptoms subside after a few days, but in some of the infected, the disease passes into a second phase, which is caused by renewed fever, lower abdominal pain and jaundice or yellowing of the skin and eyes as a result Damage to the liver is marked. In addition, there is external bleeding from the oral mucosa, the conjunctiva and nosebleeds as well as severe internal bleeding in the gastrointestinal tract as a result of serious tissue damage that leads to blood in the stool and vomiting of the blood.

If this second phase of the disease is survived, there is lifelong immunity to the disease, but yellow fever ends in around 20% of those affected.


In many cases, a detailed medical history is very informative, because it already makes clear whether or which previous illnesses, trips abroad or previous drug therapies could play a role, or whether, for example, pregnancy, working with chemicals or an increased consumption of alcohol or drugs. Accordingly, those affected should speak openly and honestly with their doctor about their symptoms, but also about their use of stimulants, so as not to run the risk of misdiagnosis.

As part of the subsequent physical examination, the doctor can quickly identify a number of causes based on noticeable changes: For example, a palpable palpable indicates a possible malignant congestion of the biliary tract, while an enlarged, more nodular liver is associated with cirrhosis of the liver - especially if there are reddened palms, a smooth red tongue and enlarged small veins of the skin.

For yellow eyes, laboratory tests are an important tool because determining the concentration of bilirubin and various enzymes, such as “gamma glutamyl transferase” (Gamma GT), provides information about possible causes. The blood count and urine test, which also includes checking hemoglobin and protein, are also helpful in the diagnosis.

In addition, there are often imaging methods for diagnosis: with conventional ultrasound, organs of the abdominal cavity can be displayed and evaluated quickly and painlessly, and changes in the surface and size of the liver or spleen, for example, can be detected.

An “endoscopic” ultrasound examination enables more precise diagnoses, in which the organs can be examined from the inside using a tubular or tubular medical instrument (endoscope). If this is not enough, a special endoscopic procedure called “Endoscopic Retrograde Cholangio-Pancreaticography” (ERCP) offers the additional option of examining the gallbladder and the pancreatic duct system using X-ray contrast media and a special endoscope for difficult diagnoses.

Magnetic resonance imaging (MRI) or computed tomography (CT) can also be used as part of the diagnosis, however, these methods are mostly used when cancer is suspected.

Treatment for yellow eyes

The treatment options depend on the respective cause and are therefore very different - especially because the yellowing of the dermis often affects children and adolescents. Depending on the distinction between "hemolytic" (due to the breakdown of red blood cells), "hepatic" (due to the liver) and "cholestatic" (caused by a drainage disorder of the bile) jaundice also varies.

For example, if there is a backlog of bile, the bile ducts are cleared of gallstones or tumors by endoscopic surgery. Small tubes made of plastic or metal (stents) are then used, which are inserted into the blocked bile duct and allow the stagnant bile to drain. If the gallbladder is persistent, it must often be surgically removed - for this purpose, gentle abdominal mirroring (laparoscopic cholecystectomy) is increasingly being used in addition to classic surgery.

Acute viral infections of the liver heal spontaneously in many cases, become chronic, but antiviral drugs are used. Various measures are also considered for the treatment of hepatitis - in the case of hepatitis B, for example, virus-inhibiting drugs (for example lamivudine) are used, which leads to a decrease in the level of bilirubin in the blood and thus to a reduction in the yellowing of the eyes and skin is coming.

If alcohol, medication or other poisons are responsible for the yellowing of the eyes, it is important to avoid these substances immediately and to clarify further treatment steps such as changing medication or possible addiction therapy with the doctor.

If the yellow eyes are based on Meulengracht's disease, this cannot be treated, because the genetic enzyme defect cannot be remedied or compensated for. However, this is not a problem for most of those affected, because usually their lifestyle can be reconciled quite well with the metabolic disorder, so that the Meulengracht means little, if any, restrictions. Avoid alcohol, smoking, infections, stress and long hunger or fasting, as this often leads to an additional increase in bilirubin.

There are no specific therapeutic approaches for the familial hyperbilirubinemia syndromes "Dubin-Johnson", "Rotor" and "Summerskill-Walshe-Tygstrup". The conservative treatment of Crigler-Najjar syndrome type 1 is usually carried out via daily phototherapy with blue lights and the use of enzyme inhibitors as well as calcium carbonate and calcium phosphate to stimulate the outflow of water-insoluble bilirubin into the intestine.

Another treatment option is liver transplantation. Since there is only a partial enzyme deficiency in Crigler-Najjar syndrome type 2, the drug "phenobarbital" is normally used for the treatment, which in most cases can lower the bilirubin level.

If there is a yellow fever infection, the therapeutic measures are aimed exclusively at treating the symptoms, since there is currently no drug that is able to effectively fight the pathogen. Since in most cases only mild complaints occur, the disease is easy to treat, but in the case of more severe courses, intensive medical care is essential. Accordingly, if yellow fever is suspected, those affected should in any case go to the care of a clinic that is experienced in dealing with tropical diseases and is appropriately equipped.

Treatment for newborn jaundice

Therapy for newborn jaundice depends on the level of bilirubin concentration in the blood: If it is a “normal”, ie harmless form of jaundice after birth with only slightly increased bilirubin values, no therapy is normally necessary - instead, the symptoms usually disappear completely after a few days, and complications are not to be expected here in healthy children.

However, if the values ​​exceed a certain limit, due to the increased risk of damage to certain brain areas (core icterus), phototherapy (light therapy) is used immediately, in which the child receives irradiation with blue light, which converts the stored water-insoluble into water-soluble bilirubin and thus can then be excreted by the body. In severe cases with very high bilirubin levels, a so-called “blood exchange” usually has to be carried out, in which the child's blood is successively replaced by suitable donor blood.

The so-called "breast milk jaundice", on the other hand, does not require therapy, and breastfeeding does not normally have to be interrupted. However, if the infant's jaundice persists over a longer period of time and other causes have been excluded, a brief interruption of breastfeeding is recommended. During this time, the milk is pumped out and boiled instead, which changes the protein contained in the heat and does not further block the breakdown of the bile pigment. If the jaundice regresses, breastfeeding can continue without problems.

Prevention of yellow eyes

As soon as the eyes turn yellow, a visit to the doctor is inevitable, so that the cause can be uncovered and the appropriate therapy can be initiated. Nevertheless, there are some ways to strengthen the overall health of the liver, spleen and pancreas in advance and thus prevent jaundice.

Since gallstones, fatty liver and pancreatitis are mostly the result of an unhealthy, high-fat diet, it is important to pay attention to a healthy, balanced and low-cholesterol diet and to always drink enough.

In this context, it should also be borne in mind that bitter and hot spices and herbs can additionally stimulate and protect the liver and bile. Therefore, for example, the chief physician of the internal department of the Habichtswald Clinic Kassel, Dr. Volker Schmiedel, to spice dishes primarily with ginger, horseradish, pepper, mustard, oregano, cinnamon, cloves and coriander, turmeric, which is normally also part of the "curry" spice mixture, is particularly effective.

On the advice of the naturopathic expert, the daily menu should also regularly include vegetables or bitter salads such as chircorée, radicchio, lollo rosso or endive, since the bitter substances contained in it enable the liver to regenerate itself.

In general, attention should also be paid to limited alcohol consumption, because alcohol is still the most common cause of severe liver damage. Medications should not be underestimated here either. In women, jaundice, for example, can often be attributed to the contraceptive pill. The absorption of toxic substances can also lead to yellow eyes and should be avoided accordingly. In this context, it is also advisable to take care with regard to occupational safety law that special safety measures are in place when handling toxic substances.

Anyone traveling to distant countries should also familiarize themselves with the possible dangers of the travel destination, because poor hygiene, for example, means that the hepatitis virus is transmitted particularly quickly via contaminated food. In addition, those affected should get enough information about mosquitoes and tropical diseases and provide the necessary protection in advance through vaccinations and medication.

Naturopathy for yellowing of the eyes

Alternative medicine offers a number of useful measures to strengthen liver health and thus prevent yellowing of the eyes.

For example, several bitter herbs of the liver and bile that are often used in naturopathy offer good support and can also help to cure various diseases and ailments of the liver.

The most effective natural liver medicinal plant is milk thistle (also thistle or fever thistle) or the active ingredient "Silymarin" obtained from the seed, which not only normalizes liver values ​​relatively quickly, but can also significantly alleviate advanced liver diseases. Accordingly, even the Federal Health Office officially recognized milk thistle for the treatment of inflammatory liver diseases, cirrhosis and toxic liver damage as a medicinal plant for internal use.

The dandelion turns out to be a veritable "miracle herb" when cut into the liver and should therefore be consumed regularly in the form of lettuce, vegetables, soup, juice or tea. In addition to its generally positive impact on overall health, the dandelion also has a "choleretic" (promoting the flow of bile). Accordingly, the plant stimulates bile production in the liver and thus leads to the elimination of the thin bile. As a result, the herb is often used for hepatitis, gallstones and cirrhosis of the liver - however, this should only be done under the supervision of an experienced alternative practitioner or doctor, which of course also applies to all other alternative medical applications.

In order to protect and support liver health, it is recommended from a naturopathic point of view to regularly carry out liver detoxification in order to rid this particularly stressed organ of accumulated toxins. In this context, homeopathic preparations are suitable, among other things, with the help of which the liver can be detoxified in a gentle way. Carduus marianus, for example, which detoxifies and protects the liver cells, comes into question. Myrica cerifera or Okoubaka also have a preferential effect on the digestive organs and are therefore used for jaundice or liver weakness.

With the help of Schüssler salts, the liver can be strengthened and detoxified, thus helping to prevent diseases and complaints such as yellow eyes. Here, for example, the Schüssler Salt No. 6 (Potassium sulfuricum D6) comes into question, which stimulates the liver and thus detoxification. The Schüssler Salt No. 3 (Ferrum phosphoricum D12) stimulates the oxygen binding to the red blood cells and thus contributes to better blood circulation and improved liver function.

Although the use of Schüssler salts has been tried and tested many times in daily practice, you should always consult your doctor or alternative practitioner before taking it to avoid possible risks or side effects. (No)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese


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Video: Severe Jaundice in Viral Hepatitis - Yellow Eyes and skin (June 2022).